Effects of intermittent theta burst stimulation on spasticity after spinal cord injury

Nardone, Raffaele; Langthaler, Patrick B.; Orioli, Andrea; Höller, Peter; Höller, Yvonne; Frey, Vanessa; Brigo, Francesco; Trinka, Eugen

doi:10.3233/rnn-160701

Cited by 22 publications

(35 citation statements)

References 25 publications

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“…It has been postulated that impaired cortical motor neurons after stroke cannot sustain inhibitory signals to the corticospinal tract, leading to an increased spinal motor neuron excitability that results in spasticity [43]. Facilitatory rTMS, including iTBS, has been reported to reduce spasticity in patients with multiple sclerosis [44, 45], cerebral palsy [46], and spinal cord injury [47, 48]. In patients with acute and chronic stroke, Kim et al found that a single session of iTBS resulted in a transient reduction of spasticity [49].…”

Section: Discussionmentioning

confidence: 99%

Intermittent theta burst stimulation enhances upper limb motor function in patients with chronic stroke: a pilot randomized controlled trial

et al. 2019

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Background Intermittent theta burst stimulation (iTBS) is a form of repetitive transcranial stimulation that has been used to enhance upper limb (UL) motor recovery. However, only limited studies have examined its efficacy in patients with chronic stroke and therefore it remains controversial. Methods This was a randomized controlled trial that enrolled patients from a rehabilitation department. Twenty-two patients with first-ever chronic and unilateral cerebral stroke, aged 30–70 years, were randomly assigned to the iTBS or control group. All patients received 1 session per day for 10 days of either iTBS or sham stimulation over the ipsilesional primary motor cortex in addition to conventional neurorehabilitation. Outcome measures were assessed before and immediately after the intervention period: Modified Ashworth Scale (MAS), Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Box and Block test (BBT), and Motor Activity Log (MAL). Analysis of covariance was adopted to compare the treatment effects between groups. Results The iTBS group had greater improvement in the MAS and FMA than the control group ( η 2 = 0.151–0.233; p < 0.05), as well as in the ARAT and BBT ( η 2 = 0.161–0.460; p < 0.05) with large effect size. Both groups showed an improvement in the BBT, and there were no significant between-group differences in MAL changes. Conclusions The iTBS induced greater gains in spasticity decrease and UL function improvement, especially in fine motor function, than sham TBS. This is a promising finding because patients with chronic stroke have a relatively low potential for fine motor function recovery. Overall, iTBS may be a beneficial adjunct therapy to neurorehabilitation for enhancing UL function. Further larger-scale study is warranted to confirm the findings and its long-term effect. Trial registration This trial was registered under ClinicalTrials.gov ID No. NCT01947413 on September 20, 2013.

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Section: Discussionmentioning

confidence: 99%

Intermittent theta burst stimulation enhances upper limb motor function in patients with chronic stroke: a pilot randomized controlled trial

et al. 2019

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“…The postulated pathophysiology of spasticity is that lesions of upper motor neuron impair the supraspinal inhibitory inputs, leading to an increased excitability of α and γ motor neurons, and of the interneurons at the spinal level, ultimately causing spasticity [34,35]. Therefore, facilitatory rTMS and iTBS had been applied to lower spasticity in patients with a number of neurologic disorders [20,33,[36][37][38][39][40][41] by modulating the excitability of cortical motor neurons. In addition, it is increasingly accepted that iTBS may modulate cortical excitability by inducing the long-term potential-like (LTP-like) plasticity changes [10,42,43], and the persistently increasing neural activity may project to inhibitory corticospinal synapses.…”

Section: Discussionmentioning

confidence: 99%

Augmented Efficacy of Intermittent Theta Burst Stimulation on the Virtual Reality-based Cycling Training for Upper Limb Function in Patients With Stroke

Chen

Huang

et al. 2020

Preprint

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Background: Virtual reality and arm cycling have been reported as effective treatment to improve upper limb motor recovery in patients with stroke. Intermittent theta burst stimulation (iTBS) can increase ipsilesional cortical excitability, and has been increasingly used in patients with stroke. However, few studies examined the augmented effect of iTBS on neurorehabilitation program. In this study, we investigated the augmented effect of iTBS on virtual reality-based cycling training (VCT) for upper limb motor function in patients with stroke.Methods: In this randomized controlled trial, 23 patients with stroke were recruited. Each patient received either 15 sessions of iTBS or sham stimulation in addition to VCT on the same day. Outcome measures, including Modified Ashworth Scale Upper Extremity (MAS-UE), Fugl-Meyer Assessment Upper Extremity (FMA-UE) for body function, Action Research Arm Test (ARAT), Nine Hole Peg Test (NHPT), Box and Block Test (BBT) and Motor Activity Log (MAL) for activity and Stroke Impact Scale (SIS) for participation were assessed before and after the intervention. Paired t test was performed to evaluate the effectiveness after the intervention and analysis of covariance (ANCOVA) was conducted to compare the therapeutic effects between two groups.Results: At post-treatment, both groups showed significant improvement in FMA-UE and ARAT, while only the iTBS group demonstrated significant improvement in MAS-UE, BBT, NHPT, MAL and SIS. ANCOVA revealed that the iTBS group presented greater improvement than the sham group significantly in MAS-UE, NHPT and SIS, and with borderline significance in ARAT, BBT and MAL. There was no significant difference in FMA-UE between groups.Conclusions: Intermittent TBS showed augmented efficacy on VCT for reducing spasticity, improving gross motor function and manual dexterity, and increasing participation in daily life in stroke patients. This study provided an integrated innovative intervention, which may be a promising therapy to improve upper limb motor function recovery, especially manual dexterity, in stroke rehabilitation. However, this study has a small sample size, and thus a further larger-scale study is warranted to confirm the treatment efficacy.Trial registration: This trial was registered under ClinicalTrials.gov ID No. NCT03350087, retrospectively registered, on November 22, 2017.

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“…I. Spinal cord injury (SCI): rTMS has emerged as a promising therapeutic technique for SCI patients (de Araújo et al, 2017;Nardone et al, 2017), and the technique has been applied to alleviate some of the main consequences of SCI, including sensory and motor function impairments, spasticity, and neuropathic pain (Tazoe and Perez, 2015;Gunduz et al, 2017). rTMS has also been used in animal experiments on SCI.…”

Section: Abstract As Indicators Of Emerging Trendsmentioning

confidence: 99%

Trends of Repetitive Transcranial Magnetic Stimulation From 2009 to 2018: A Bibliometric Analysis

et al. 2020

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Repetitive transcranial magnetic stimulation (rTMS) technology, which is amongst the most used non-invasive brain stimulation techniques currently available, has developed rapidly from 2009 to 2018. However, reports on the trends of rTMS using bibliometric analysis are rare. The goal of the present bibliometric analysis is to analyze and visualize the trends of rTMS, including general (publication patterns) and emerging trends (research frontiers), over the last 10 years by using the visual analytic tool CiteSpace V. Publications related to rTMS from 2009 to 2018 were retrieved from the Web of Science (WoS) database, including 2,986 peer-reviewed articles/reviews. Active authors, journals, institutions, and countries were identified by WoS and visualized by CiteSpace V, which could also detect burst changes to identify emerging trends. GraphPad Prism 8 was used to analyze the time trend of annual publication outputs. The USA ranked first in this field. Pascual-Leone A (author A), Fitzgerald PB (author B), George MS (author C), Lefaucheur JP (author D), and Fregni F (author E) made great contributions to this field of study. The most prolific institution to publish rTMS-related publications in the last decade was the University of Toronto. The journal Brain Stimulation published most papers. Lefaucheur et al.'s paper in 2014, and the keyword "sham controlled trial" showed the strongest citation bursts by the end of 2018, which indicates increased attention to the underlying work, thereby indicating the research frontiers. This study reveals the publication patterns and emerging trends of rTMS based on the records published from 2009 to 2018. The insights obtained have reference values for the future research and application of rTMS.

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Effects of intermittent theta burst stimulation on spasticity after spinal cord injury

Abstract: These findings suggest that iTBS may be a promising therapeutic tool for the spasticity in SCI patients.

Cited by 22 publications

References 25 publications

Intermittent theta burst stimulation enhances upper limb motor function in patients with chronic stroke: a pilot randomized controlled trial

Intermittent theta burst stimulation enhances upper limb motor function in patients with chronic stroke: a pilot randomized controlled trial

Augmented Efficacy of Intermittent Theta Burst Stimulation on the Virtual Reality-based Cycling Training for Upper Limb Function in Patients With Stroke

Trends of Repetitive Transcranial Magnetic Stimulation From 2009 to 2018: A Bibliometric Analysis

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